Can Fibroid Size and Location Predict Your Risk of Expulsion?
Alicia Armeli

By age 50, greater than 50% of women develop uterine fibroids, a noncancerous tumor that grows in the wall of the uterus.1  Fibroids can be the cause of heavy periods, pelvic pain, and urinary symptoms, leaving many women seeking treatment.

Uterine fibroid embolization (UFE)—a minimally invasive fibroid treatment performed by an interventional radiologist—blocks blood flow to the fibroids, causing them to gradually shrink and symptoms to improve. UFE complications are rare but do happen, including fibroid tissue passing from the body—an incident called fibroid expulsion that occurs in approximately 5-10% of women.2,3 A recent study by physicians at MedStar Georgetown University Hospital found that the risk of expulsion can be predicted by fibroid size and location.4

“Fibroid expulsion is an important topic because the passage of fibroids can lead to other complications,” says Theresa Caridi, MD, Assistant Professor in the Division of Vascular and Interventional Radiology at MedStar Georgetown University Hospital in Washington, D.C., and co-author of the study. “Our research enables us to see who’s most at risk and understand that there may be women who are better candidates for UFE than others. This information will also help patients know what to expect.”

The study included 230 women treated with UFE between 2011 and 2014.4  Pre-procedure MRI was used to predict the likelihood of fibroid expulsion for each patient, and post-procedure records were reviewed to determine the accuracy of that prediction. Results presented at the Society of Interventional Radiology meeting showed that women with larger fibroids and fibroids with large endometrial interface were at a greater risk of expulsion.

“Fibroids that have a large endometrial interface are those that are most in contact with the inner lining of the uterus,” explains Dr. Caridi. “We found fibroids in this location, often called submucosal fibroids, and those that are larger in size are at the greatest risk for passage.”

During fibroid expulsion, it’s possible for women to pass an entire tumor or small pieces of fibroid tissue. “In this study, 50% of patients with fibroid passage required no intervention,” Dr. Caridi clarifies. “A cause for concern is when a fibroid doesn’t pass completely, dilating the cervix and allowing normal bacteria from the vagina to ascend into the uterus, causing an infection.”

What should a woman do if she thinks she’s passing a fibroid?

According to Dr. Caridi, the first thing a woman can do is be aware of the expected symptoms but also know when to seek medical help. A woman should call her interventional radiologist if she experiences symptoms beyond small tissue passage, such as malodorous discharge, pain, and fever.

“Sometimes fibroid expulsion is something we can handle over the phone or within our clinic, and sometimes it’s necessary for a woman to see her gynecologist in case she needs to have the rest of the fibroid removed,” Dr. Caridi notes. “Rarely, infection of the uterus that is unresponsive to antibiotics can occur, and a hysterectomy may be necessary. With UFE we’re planning on avoiding removal of the uterus, but ultimately there’s a rare chance of a hysterectomy, and that’s something we talk about with a patient in our clinic visit prior to undergoing UFE.”

Shedding more light on the risk of fibroid expulsion offers women a vital piece of information that will ultimately help them seek out the best treatment possible for their condition. “Based on our findings, we are able to provide women with a percentage of how great their risk is for fibroid expulsion,” Dr. Caridi tells Ask4UFE. “Knowing fibroid expulsion could happen and addressing expectations appropriately can help a woman make treatment decisions that are right for her.”

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad, and volunteering in her community. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR Theresa Caridi, MD, is an assistant professor in the Division of Vascular and Interventional Radiology at MedStar Georgetown University Hospital in Washington, D.C.

In addition to teaching and providing patient care, Dr. Caridi serves as the medical student clerkship director for interventional radiology at MedStar Georgetown University Hospital. She is an active member of the Society of Interventional Radiology (SIR) for which she serves on a national committee. Her special interests include women’s health and pulmonary arteriovenous malformations (AVMs).

REFERENCES

  1. Baird, D. D., Dunson, D. B., Hill, M. C., et al. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence.Am J Obstet Gynecol, Jan; 188(1), 100–107.
  2. Shlansky-Goldberg, R., Coryell, L., Stavropoulos, W., et al. (2011). Outcomes following fibroid expulsion after uterine artery embolization. J Vasc Interv Radiol, Nov; 22(11): 1586-1593.
  3. Lohle, P.N., Boekkooi, F. P., Smeets, A. J., et al. (2006). Limited uterine artery embolization for leiomyomas with trisacryl gelatin microspheres: 1-year follow up. J Vasc Interv Radiol, Feb; 17(2 Pt 1): 283-287.
  4. Han, C., Caridi, T., & Spies, J. (2017). Prediction of the likelihood of fibroid expulsion after uterine fibroid embolization (UFE). J Vasc Interv Radiol, Feb; 28(2): S46.